Pain often improves in older veterans

Older military veterans frequently show improvements in pain intensity over time. However, opioids, some mental health conditions and certain pain diagnoses are associated with lower likelihood of improvement, according to research reported in The Journal of Pain.

The aging veteran population is at especially high risk for persistent pain. Unfortunately, little is known about factors linked with positive and negative outcomes over time. Furthermore, older adults have the highest prevalence of long-term use of pain medications, including opioids.

Researchers at the Department of Veterans Affairs Center to Improve Veterans Involvement in Care and Oregon Health & Science University sought to identify clinical and demographic factors associated with changes in pain scores over time in a national cohort of veterans 65 and older with chronic pain. They hypothesised that older age and comorbid mental health disorders would be associated with less improvement in pain conditions over time.

The study examined a database of some 13,000 veterans receiving treatment in the VA system who had elevated numeric rating pain scores and had not been prescribed opioids. They measured the percentage decrease over 12 months in average pain intensity scores and the time to sustained improvement.

Results showed that nearly two-thirds of these patients met criteria for sustained improvement during the 12-month follow up period. A key finding was initiation of opioid therapy was associated with lower likelihood for sustained improvement. Other factors associated with poor improvement were service-connected disability and mental health problems, chronic low back pain, neuropathy and fibromyalgia/myofascial pain diagnoses.

“We found that older veterans often show improvements in pain intensity over time, and that opioid prescriptions, mental health conditions and certain pain diagnoses are associated with lower likelihood of improvement,” said Steven Dobscha, lead author and professor of psychiatry at Oregon Health and Sciences University. “Further, the oldest group of veterans within the sample demonstrated the most improvements in pain intensity. This supports prior research indicating that as age increases, patterns and perceptions of pain may change and suggests that many older people with pain adjust and cope better over time.”

Although two-thirds of the sample experienced pain improvement over time, a substantial minority of veterans did not show reductions in pain intensity, and some had exacerbated pain.

Dobscha said the study findings call for further evaluation of pain outcomes in older adults and that in particular there is a need for more research to study relationship between prescription opioids and treatment outcomes over time.